Acute and chronic side effects of corticosteroids used for treatment of neonatal conditions

Prematurity is a large problem worldwide. Premature infants are at high risk of developing chronic lung disease (CLD). Corticosteroids (CS) have been proven efficient in improving lung function and facilitating weaning of premature infants with CLD from mechanical ventilation. On the other hand, their use has been related to severe short and long-term side effects. Over the years, CS have been widely used in many conditions in premature infants, but after a connection to severe side effects had been established, their use registered a large downfall, creating the perplexity whether to give CS or not. Clinicians may also be confused in deciding which synthetic CS to use and at what time, dose and duration. A difference in activity and side effects between dexamethasone (DEX) and hydrocortisone (HC) should thereby also be considered. This review describes acute and chronic side effects connected to CS and will attempt to shed light on how clinicians can minimize them

Incidencija tumora središnjega živčanog sustava u bolesnika hospitaliziranih u Kliničkom bolničkom centru Split od 1. siječnja 2004. do 31. prosinca 2013. godine

The aim was to evaluate the incidence and characteristics of central nervous system tumors in patients hospitalized at the Department of Neurology, Split University Hospital Centre, during a 10-year period. The study included data on 859 patients with the diagnosis of central nervous system (CNS) tumor. Diagnosis was based on the routine CNS neuroimaging methods (computed tomography/magnetic resonance imaging). Access to patient medical records provided demographic and clinical data, continued by collection of data on potential lethal outcome of patients at the Registrar’s Office. The study was conducted at the Department of Neurology, Split University Hospital Centre, from January 1, 2004 to December 31, 2013. There were 448 male and 411 female patients. Median age at the diagnosis was 65 (range, 18-95) years. Primary CNS tumors were diagnosed in 527 patients, including 30 primary recurrent tumors, whereas 328 patients had metastatic tumors; in 4 cases, it was impossible to determine whether the tumor was a primary one or metastasis based on CNS neuroimaging. The primary tumors proved to be more common than the metastatic ones (χ2-test, p<0.05). Multiple tumor transplants were more common than solitary (211 vs. 117; the conclusion was made at a 95% level of confidence; χ2-test, p<0.05). The majority of metastases originated from the lung (bronchus and pleura cancer; 46.41%; χ2-test, p<0.05; 95% CI). The most common localization of CNS tumors was supratentorial. Based on the double-logarithmic model, we proved with sta-tistical significance that there was an increase in the incidence of CNS tumors (p=0.001). The most common tumors studied were supratentorially localized meningiomas.Cilj je bio ispitati incidenciju i značajke tumora središnjega živčanog sustava (SŽS) u bolesnika hospitaliziranih u Klinici za neurologiju Kliničkoga bolničkog centra Split u desetogodišnjem razdoblju. U razdoblju od 1. siječnja 2004. do 31. prosinca 2013. godine u Klinici za neurologiju je bilo hospitalizirano 859 bolesnika s tumorima SŽS. Dijagnoza se temeljila na nalazima slikovnih dijagnostičkih metoda (kompjutorizirana tomografija/magnetska rezonancija mozga). Demografski i klinički podaci su prikupljeni iz povijesti bolesti bolesnika. S ciljem određivanja stope smrtnosti studija je nastavljena i ­prikupljanjem podatka iz Matične knjige umrlih. U promatranom razdoblju ukupno je bilo 448 muškaraca i 411 žena s ­tumorima SŽS. Prosječna dob postavljanja dijagnoze je bila 65 godina. Primarni tumori SŽS su dijagnosticirani u 527 ­bolesnika, uključivo 30 bolesnika s recidivirajućim primarnim tumorima, a 328 bolesnika je imalo metastatske tumore. U 4 bolesnika nije bilo moguće odrediti je li se radilo o primarnom tumoru ili metastazi na temelju neuroradioloških nalaza. Primarni tumori su bili češći od metastatskih (χ2-test, p<0,05). Multiple presadnice su bile češće od solitarnih (211 prema 117, 95% CI; χ2-test, p<0,05). Većina metastaza je bila podrijetlom iz tumora pluća (46,41%; χ2-test, p<0,05; 95% CI). Najčešći su bili supratentorijski lokalizirani tumori SŽS. Primjenom dvostruko-logaritamskog modela pokazali smo da postoji statistički začajan porast incidencije tumora SŽS u ispitivanom razdoblju. Od svih tumora SŽS najčešći su bili suptratentorijski meningeomi

In vitro dissolution/release methods for mucosal delivery systems

In vitro dissolution/release tests are an indispensable tool in the drug product development, its quality control and the regulatory approval process. Mucosal drug delivery systems are designed to provide both local and systemic drug action following ocular, nasal, oromucosal, vaginal or rectal administration. They exhibit significant differences in formulation design, physicochemical characteristics and drug release properties. Therefore it is not possible to devise a single method which would be suitable for release testing of such versatile and complex dosage forms. Different apparatuses and techniques for in vitro release testing for mucosal delivery systems considering the specific conditions at the administration site are described. In general, compendial apparatuses and methods should be used as a first approach in method development when applicable. However, to assure adequate simulation of conditions in vivo, novel biorelevant in vitro dissolution/release methods should be developed. Equipment set up, the selection of dissolution media and volume, membrane type, agitation speed, temperature, and assay analysis technique need to be carefully defined based on mucosal drug delivery system characteristics. All those parameters depend on the delivery system and physiological conditions at the site of application and may vary in a wide range, which will be discussed in details

In vitro dissolution/release methods for mucosal delivery systems

In vitro dissolution/release tests are an indispensable tool in the drug product development, its quality control and the regulatory approval process. Mucosal drug delivery systems are designed to provide both local and systemic drug action following ocular, nasal, oromucosal, vaginal or rectal administration. They exhibit significant differences in formulation design, physicochemical characteristics and drug release properties. Therefore it is not possible to devise a single method which would be suitable for release testing of such versatile and complex dosage forms. Different apparatuses and techniques for in vitro release testing for mucosal delivery systems considering the specific conditions at the administration site are described. In general, compendial apparatuses and methods should be used as a first approach in method development when applicable. However, to assure adequate simulation of conditions in vivo, novel biorelevant in vitro dissolution/release methods should be developed. Equipment set up, the selection of dissolution media and volume, membrane type, agitation speed, temperature, and assay analysis technique need to be carefully defined based on mucosal drug delivery system characteristics. All those parameters depend on the delivery system and physiological conditions at the site of application and may vary in a wide range, which will be discussed in details

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Incidence of Central Nervous System Tumors in Patients Hospitalized at Split University Hospital Centre During a Ten-Year Period (January 1, 2004 – December 31, 2013)

The aim was to evaluate the incidence and characteristics of central nervous system tumors in patients hospitalized at the Department of Neurology, Split University Hospital Centre, during a 10-year period. The study included data on 859 patients with the diagnosis of central nervous system (CNS) tumor. Diagnosis was based on the routine CNS neuroimaging methods (computed tomography/magnetic resonance imaging). Access to patient medical records provided demographic and clinical data, continued by collection of data on potential lethal outcome of patients at the Registrar’s Office. The study was conducted at the Department of Neurology, Split University Hospital Centre, from January 1, 2004 to December 31, 2013. There were 448 male and 411 female patients. Median age at the diagnosis was 65 (range, 18-95) years. Primary CNS tumors were diagnosed in 527 patients, including 30 primary recurrent tumors, whereas 328 patients had metastatic tumors; in 4 cases, it was impossible to determine whether the tumor was a primary one or metastasis based on CNS neuroimaging. The primary tumors proved to be more common than the metastatic ones (χ2-test, p<0.05). Multiple tumor transplants were more common than solitary (211 vs. 117; the conclusion was made at a 95% level of confidence; χ2-test, p<0.05). The majority of metastases originated from the lung (bronchus and pleura cancer; 46.41%; χ2-test, p<0.05; 95% CI). The most common localization of CNS tumors was supratentorial. Based on the double-logarithmic model, we proved with sta-tistical significance that there was an increase in the incidence of CNS tumors (p=0.001). The most common tumors studied were supratentorially localized meningiomas

CT/MR ARTROGRAFIJA ŠAKE S APLIKACIJOM KONTRASTNOG SREDSTVA POD KONTROLOM UZV

Prije ere magnetske rezonancije (MR) u radiologiji izvodile su se artrografije na klasičnim rendgenskim aparatima (RTG), no tim se su snimkama mogle dobiti samo indirektne informacije o rupturama ili drugim lezijama zglobova. Uvođenjem CT-a u radiologiju 70-ih godina stoljeća uvodi se i CT artrografija (CTA). Zadnjih tridesetak godina izvode se MR artrografije (MRA), u početku najviše na zglobovima koljena, ramena i kuka, no moguće je aplicirati kontrastno sredstvo u svaki zglob radi bolje vizualizacije hrskavičnih i ligamentarnih struktura i radi vizualizacije slobodnih zglobnih tijela. Kako bi se precizno injiciralo kontrastno sredstvo, moguće je kontrolirati aplikaciju pod fluoroskopijom ili pod kontrolom kompjuterizirane tomografije (CT), što uključuje ionizirano zračenje, no moguće je injicirati i pod kontrolom ultrazvuka (UZV-a) (1). Ovim radom želimo prikazati tehniku artrografije ručnog zgloba pod kontrolom UZV-a te prezentirati rad Odjela za muskuloskeletnu radiologiju Kliničkog zavoda za dijagnostičku i intervencijsku radiologiju Kliničkog bolničkog centra Zagreb

The impact of hyperosmolarity on long-term outcome in patients presenting with severe hyperglycemic crisis: a population based study

AIMS: We compared characteristics of patients with hyperglycemic hyperosmolar state (HHS) and patients with severe hyperglycemia without the signs of hyperosmolarity and ketoacidosis; analyzed long-term all-cause mortality and potential prognostic factors. ----- METHODS: The studied population included 261 749 adults. HHS was diagnosed in patients with plasma glucose >33.0 mmol/L, ketonuria 320 mmol/L. Patients with plasma glucose >33.0 mmol/L, ketonuria <1+ and serum osmolarity <320 mmol/L were considered as controls (nHHS). ----- RESULTS: During the 5-year period, we observed 68 episodes of HHS in 66 patients and 51 patients with nHHS. Patients with HHS were significantly older, had lower BMI, higher serum C-reactive protein and used diuretics and benzodiazepines more frequently. Mortality rates one, three and 12 months after admission were 19.0, 32.1 and 35.7% in the HHS group, and 4.8, 6.3 and 9.4% in the nHHS group (P<0.001). However, after adjustment for patient age, these differences were not statistically significant. In multivariate Cox regression in HHS group, mortality was positively associated with age, male gender, leukocyte count, amylase, presence of dyspnea and altered mental status, and the use of benzodiazepines, ACE inhibitors and sulphonylureas, while it was inversely associated with plasma glucose, bicarbonate, and the use of thiazides and statins. A nomogram derived from these variables had an accuracy of 89% in predicting lethal outcome. ----- CONCLUSIONS: Infection, use of furosemide and benzodiazepines may be important precipitating factors of HHS. Prospective clinical trials are mandatory to analyze the safety of ACE-inhibitors and benzodiazepines in elderly patients with diabetes